Most common are (1) degenerative calcification of a congenitally bicuspid valve, (2) chronic deterioration of a trileaflet valve, and (3) rheumatic disease (almost always associated with rheumatic mitral disease).
Symptoms
Exertional dyspnea, angina, and syncope are cardinal symptoms; they occur late, after years of obstruction and aortic valve area ≤1.0 cm2.
Physical Examination
Weak and delayed (parvus et tardus) arterial pulses with carotid thrill. Double apical impulse (palpable S4); A2 soft or absent; S4 common. Diamond-shaped systolic murmur ≥ grade 3/6, often with systolic thrill. Murmur is typically loudest at second right intercostal space, with radiation to carotids and sometimes to the apex (Gallavardin effect).
ECG
Often shows LV hypertrophy, but not useful for predicting gradient.
Echocardiogram
Shows LV hypertrophy, calcification and thickening of aortic valve cusps with reduced systolic opening. Dilatation and reduced contraction of LV indicate poor prognosis. Doppler quantitates systolic gradient and allows calculation of valve area.
Aortic Stenosis TREATMENT
Avoid strenuous activity in severe AS, even in asymptomatic phase. Treat heart failure in standard fashion , but use vasodilators with caution in pts with advanced disease. Valve replacement is indicated in adults with symptoms resulting from AS and hemodynamic evidence
of severe obstruction. Transcatheter aortic valve implantation (TAVI) is an investigational approach for pts at excessive surgical risk that has demonstrated favorable results.
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